Answers to Common Questions arisingafter Circumcision of a Youth, Teen or Adult

What follows is a compendium of the most common questions posted to CIRCLIST by men who have recently been circumcised. Whilst our answers are the most typical response to these queries, your own doctor can advise you best about what to expect and how to care for your freshly circumcised penis.

UTC

Just Home from the Doctor:

A compression bandage is most commonly wrapped around the outside of the newly circumcised penis. This is an elastic bandage that helps to reduce swelling by applying pressure to the penis. The tip of glans is exposed, permitting you to urinate in an unobstructed manner. Underneath the compression bandage will be a white gauze bandage, intended to soak up any leakage or bleeding. Doctors typically recommend keeping the bandages in place for three days post circumcision.

For first 12 to 24 hours it is advised to keep the penis level with the heart (IE lay down and relax). This supposedly helps reduce swelling and bruising. When the anaesthetic wears off, be prepared for a burning or tingling sensation. Most physicians provide pain medication, but common pain relievers like Tylenol usually are sufficient. Avoid blood-thinning pain relievers such as aspirin, which could increase bruising.

Taking a Shower:

When taking a shower duing these first few days, you must ensure that the penis and its bandage remain dry. A condom is the best way to achieve this if one just wishes to shower briefly. On a younger boy, a latex finger protector (available from any pharmacy or drug store) works well.

The Unveiling:

By now it’s probably day three or so post circumcision and you are about to unwrap your newly circumcised penis. Usually you can find the end of the bandage and just unwrap the elastic compression bandage. You may also be able to simply unwrap the gauze bandage. However, if this is difficult you can soak the bandages to help loosen them, then unwrap the penis. If this fails, the bandage can be cut away with blunt scissors. When pulling the wrapping away from the penis do so with care, as it may stick to portions of the incision line that have bled or be caught on sutures. Once unwrapped, be prepared for your penis to look a little sore and even bruised. Typically bruising comes a day or more after you unwrap, and you can have bruising all the way down to the scrotum. Sometime the penis looks great when first unwrapped, but then looks progressively worse as swelling and bruising occur during the next 4 to 8 days. This is normal.

Sleeping and Erections:

If you become fully erect whilst still wearing the compression bandage, such that the glans is overly swelled out in front of the compression bandage and has become dark in colour, it is best to remove the compression bandage to restore normal circulation. Usually, until the compression bandage is removed, normal erections are not possible. Removal of the compression bandage permits your penis to become erect during the night. You probably never realised that you have nocturnal erections 3 to 8 times per night but this is perfectly normal and healthy.

Most newly circumcised men find the biggest problem is the night time erections that occur from the time the compression bandage is removed until the sutures are removed. The sutures are stretched during these erections, which can be rather painful. The pain will typically wake you and you will usually immediately soften in response to the pain. You may find it useful to either pull your knees up to your chest or to get out of the bed and stand momentarily while the erection subsides. These night time erections will not cause any damage to your newly circumcised penis, but they are bothersome and the reason most men seek to remove the sutures sooner rather than later. Occasionally, but rarely, a suture may break due to erections. This will normally be no problem even if the wound opens slightly, as the remaining sutures will hold it sufficiently together for healing to continue. Minor bleeding in this situation can be dealt with by firm pressure for up to five minutes. Continued bleeding beyond that requires re-suturing and thus a visit to a medical professional.

Swelling of the Inner Foreskin:

If you received a ‘high’ style of circumcision, you have some inner foreskin remaining on your penis, now turned to face outwards and pulled back down the shaft towards your body. This tissue is very sensitive, like the inner part of your eyelids. Following circumcision it swells and can be paticularly painful during healing. Many men that have had a ‘high’ circumcision report the inner foreskin swelling and looking like a puffy ring of tissue bunched up behind the glans. This may be a bit irritating but will subside in a matter of days. Cold compresses twice daily for 15 to 30 minutes may help to relieve the discomfort and reduce the swelling of this extra-sensitive tissue.

Underwear:

If you normally wear boxers you may find that in the immediate post-operative period they give insufficient support. You may wish to consider some form of briefs that hold your penis in position and thus reduce the frictional stimulation which it would otherwise receive if allowed to swing freely.

Urination:

Do not be surprised if your urine tends to spray instead of forming a neat stream for the first few days. This is a natural result of the swelling and will correct itself as the swelling subsides.

The Frenulum:

If you had your frenulum removed, the physician may or may not have sutured the incision in this area. If he did not, the area will very likely produce and drain lymphatic fluids. These clear fluids may continue to drain even after you remove your dressing, requiring you to reapply a loose dressing in this area so as not to stain your underpants. Draining from this area is normal, as is some additional bleeding. This is typically the last area to fully heal, due to the depth of the incision and the nature of the tissue involved.

Suture Removal:

Typically, sutures are removed sometime between day 5 and day 15. Most physicians prefer to leave them in longer, and most patients want them out sooner. You will have to make this determination based on your own rate of healing and the recommendation of your physician. Removing them sooner has the advantage of letting you sleep easier. Additionally, getting them out sooner ensures that there will be no suture tunnels or suture marks. The longer they remain, the more likely the sutures will leave tunnels under the skin or at least markings where they were inserted. However, removing them too early can also lead to the wound reopening, which is not good.

To remove the sutures you can go to your physician or a local emergency room, or they can be removed them at home (either done yourself or by a loved one.) Most sutures used in circumcision are the self dissolving variety (“soluble”). However, these rarely dissolve completely on their own and certainly they are not going to be fully dissolved by day 5 or even day 10. Both dissolving and traditional sutures need removed manually, unless of course they have already dissolved on their own. Some physicians leave long tails on the sutures whilst others clip each suture very close to the skin. Long tails make removing the sutures very simple to do, but closely cut sutures are less of a day-to-day problem because they don’t get caught so easily on underpants (causing you pain).

If you choose to remove them yourself then it is a good idea initially to remove only alternate sutures, then to check that the wound does not open at all. Sterilize a pair of fine pointed cuticle scissors and a pair of flat-bladed tweezers. Wash your hands and penis thoroughly. Carefully cut through a stitch near the knot and pull it out by grasping the knot in the tweezers. Do not be surprised if the location bleeds a bit; in fact this is good as it indicates that a ‘stitch tunnel’ has not yet formed. If the incision line opens, stop and wait another couple of days before trying again - no harm will come from a small opening. If the wound does not open anywhere then continue by removing the remaining sutures. After removal, there will be some minor blood spotting and you should use a mild antibiotic moisturizer such as Neosporin™ on the incision line to ensure that you don’t get an infection. You should not use strong antiseptics such as Dettol, as these tend to delay healing by attacking the newly forming skin at the circumcision line. You may want to put a light gauze dressing on the incision line if you are going to wear underpants until the suture points form a scab or close. Additionally, regular treatment of the incision line with a mild antibiotic moisturizer during the first weeks post-circumcision will help the incision line’s ultimate appearance.

If your frenulum was removed and there are sutures in this area, they can sometimes be scabbed, covered and not easily removed. You can wait until the scab falls off before attempting removal in this area, or leave them (if the soluble type) to dissolve on their own.

Peeling:

As part of the healing process the glans will likely peel, unless you have routinely kept for your foreskin pulled back prior to the circumcision. If not, you can expect a sort of "dry skin" to form over the glans (between 2 to 4 weeks post circ, typically) which will peel off. It will almost seem like your glans had sunburn. This is not a problem and is perfectly normal for the newly exposed and now drying glans.

Masturbation:

“When can I masturbate?” is a very frequent question. That depends on how quickly you are healing and how gentle you can be. Typically the sutures must be removed before erection is comfortable, so this answer somewhat depends upon when you removed the sutures. We typically suggest you wait at least five days past suture removal before attempting to masturbate. The longer you can wait the better for your penis, but perhaps not for your state of mind. When you do masturbate, gently massage only the glans avoiding the frenulum area if it was removed. Typically just a very light stroke restricted to the newly bared head (touching the glans only, NOT pumping the shaft) will be sufficient to bring you to a very deep and very powerful first orgasm. Once you have had your first release post-circumcision, wait several more days before attempting a second masturbation. Give your penis as much time to heal as possible. Most physicians recommend you wait a full 30 days before returning to your regular masturbation schedule (with lubrication or dry). No doubt your masturbation technique will also change at this time as you learn to stimulate your circumcised penis. Slipping the foreskin up and down over the glans is no longer possible!

Resuming Sexual Relations:

This has most to do with how quickly you are healing and when you removed the sutures. Most authorities say to wait 45 days post circumcision before attempting intercourse. It is likely you won’t damage anything if you have sex in 35 days, but as noted above, the more time you can give your circumcised penis to heal, the better. Some men report having returned to intercourse (gently) by day 15, others wait the recommended 45 days before trying. You will have to make this decision based on a number of personal factors including your rate of healing, your partner’s needs and so on. Remember that full healing can take up to six months and you obviously won’t be able to wait that long. Thus finding just the right amount of time is a personal choice which you should seriously consider.

Final Results:

Many men post questions asking when their penis will look ‘normal’ and be fully healed. As noted above, the initial swelling and bruising will go away in the first few weeks. The general consensus seems to be that full healing takes a number of months, perhaps as many as six, before the ‘final results’ can be seen. Even when the swelling and bruising are gone, the penis continues to heal inside. Be patient and wait for the final result before determining if you are fully happy with your circumcision style.

For more detailed advice...

The Yahoo Group Inter-Circ has produced a 16-page booklet on the subject of post-circumcision care, written by an MD. Access is for members only. Join the Group and then access the information at https://groups.yahoo.com/neo/groups/Inter-Circ/files/AdultPostOpCare/. Elsewhere in the Files section of the Inter-Circ Group you will find the same text in Spanish, along with English and Spanish texts relating to post-circumcision care of infant and child patients.